前交叉韧带重建中不同入路建立股骨隧道的效果比较  

Effect of different reconstruction approaches of anterior cruciate ligament in the construction of femoral tunnel

作　　者：林军 郑秋坚[2] LIN Jun;ZHENG Qiu-jian(Department of Jiont Surgery,Affiliated Nanhai Hospital of Southern Medical University,Foshan 528000,Guangdong,CHINA;Department of Jiont Surgery,Guangdong Provincial People's Hosipital,Guangzhou 510000,Guangdong,CHINA)

机构地区：[1]南方医科大学附属南海医院关节外科,广东佛山528000 [2]广东省人民医院关节外科,广东广州510000

出　　处：《海南医学》2020年第23期3064-3067,共4页Hainan Medical Journal

基　　金：广东省佛山市医学类科技攻关项目(编号:1920001001814)。

摘　　要：目的比较经胫骨入路、经前内侧入路、经前内侧低位辅助入路在前交叉韧带重建中的应用效果。方法回顾性分析2011年3月至2016年12月南方医科大学附属南海医院收治的54例前交叉韧带重建患者的临床资料,所有患者均术后随访6个月以上,其中经胫骨入路(A组)、经前内侧入路(B组)、经前内侧低位辅助入路(C组)患者各18例。所有患者术中均记录股骨隧道长度,术后通过X线片测量股骨隧道在冠状面与内外髁连线及矢状面与股骨干轴线的夹角,术后行Lachman试验、轴移试验检查评定膝关节稳定性。结果 A组、B组、C组患者的股骨隧道长度分别为(48.45±4.35.00) mm、(36.25±5.45) mm、(33.25±3.45) mm,A组股骨隧道长于B组和C组,差异均有统计学意义(P<0.05);A组、B组、C组患者的股骨冠状面隧道与内外髁连线夹角分别为(61.20±4.83)°、(51.67±06.12)°、(46.63±5.49)°,矢状面隧道与股骨干轴线的夹角分别为(43.25±5.24)°、(30.78°±6.58)°、(28.79°±5.46)°,A组患者的冠状面及矢状面股骨隧道角度明显大于较B组和C组,差异均有统计学意义(P<0.05),而B组和C组间比较差异均无统计学意义(P>0.05);Lachman试验及轴移试验阴性率分别为A组78.6%、64.3%,B组87.0%、87.0%,C组88.1%、89.3%,B组和C组明显高于A组,差异均有统计学意义(P<0.05)。结论经前内侧入路及经前内侧低位辅助入路较经胫骨入路更有利于维持旋转稳定性,经前内侧低位辅助入路能获得更好的镜下视野、更便利的获得准确的定位且可获得足够的隧道长度。Objective To compare the application effect of transtibial, anteromedial portal(AMP) and accessory anteromedial portal(AAMP) techniques in the reconstruction of anterior cruciate ligament. Methods The clinical data of 54 patients with anterior cruciate ligament reconstruction admitted to Department of Jiont Surgery, Affiliated Nanhai Hospital of Southern Medical University from March 2011 to December 2016 were retrospectively analyzed. All patients were followed up for more than 6 months after surgery, including 18 patients with the transtibial(group A), 18 AMP(group B) and 18 AAMP(group C). The length of the femoral tunnel was recorded in all patients, and the angle of the femoral tunnel was measured by X-Ray. The stability of knee joint was evaluated by Lachman test and Pivot-shift test.Results The length of femoral tunnel in group A was(48.45±4.35.00) mm, which was significantly longer than(36.25±5.45) mm and(33.25±3.45) mm in groups B and C(P<0.05). The angles of the femoral coronal tunnel and the internal and external condyle and angles between sagittal tunnel and femoral shaft in group A were(61.20±4.83)° and(43.25±5.24)°, respectively, which were significantly greater than corresponding(51.67±6.12)° and(30.78±6.58)° in group B and(46.63±5.49)° and(28.79±5.46)° in group C(all P<0.05), and there was no statistically significant difference between group B and group C. The negative rates of Lachman test and Pivot-shift test in group A were 78.6% and 64.3%, which were significantly smaller than 87.0% and 87.0% in group B and 88.1% and 89.3% in group C(all P<0.05). Conclusion AMP and AAMP are more favorable to maintain rotation stability than transtibial approach. AAMP can obtain better vision, more convenient location and sufficient tunnel length.

关 键 词：前交叉韧带重建 经胫骨入路 经前内侧入路 经前内侧低位辅助入路 疗效 

分 类 号：R687.3[医药卫生—骨科学]